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Introduction: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation. Objective: This study identified regions with high farm‐related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr. Design: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age‐standardised incidence rates (per 1000 population/year) were calculated. Findings: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm‐related. The overall age‐standardised rate for farm‐related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm‐related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two‐thirds of farm‐related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1 m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%). Discussion and Conclusion: This study provides data to inform future research and resource allocation for the prevention of farm‐related injuries. [ABSTRACT FROM AUTHOR]

Hematological malignancies may require rapid-onset treatment because of their short doubling time, notably observed in acute leukemias and specific high-grade lymphomas. Furthermore, in targeted onco-hematological scenarios, chemotherapy is deemed necessary as an emergency measure when facing short-term, life-threatening complications associated with highly chemosensitive hematological malignancies. The risks inherent in the disease itself, or in the initiation of treatment, may then require admission to the intensive care unit (ICU) to optimize monitoring and initial management protocols. Hyperleukocytosis and leukostasis in acute leukemias, tumor lysis syndrome, and disseminated intravascular coagulation are the most frequent onco-hematological complications requiring the implementation of emergency chemotherapy in the ICU. Chemotherapy must also be started urgently in secondary hemophagocytic lymphohistiocytosis. Tumor-induced microangiopathic hemolytic anemia and plasma hyperviscosity due to malignant monoclonal gammopathy represent infrequent yet substantial indications for emergency chemotherapy. In all cases, the administration of emergency chemotherapy in the ICU requires close collaboration between intensivists and hematology specialists. In this review, we provide valuable insights that aid in the identification and treatment of patients requiring emergency chemotherapy in the ICU, offering diagnostic tools and guidance for their overall initial management. [ABSTRACT FROM AUTHOR]

City of Chicago officials adopted a "racial equity" approach to mitigate the disproportionate racial impact of COVID-19, yet according to interviews with racially and socioeconomically marginalized Chicagoans, this approach failed to address core vulnerabilities associated with health, housing, mental health, and welfare. This article argues that COVID-19 represents and reifies the convergence of three sets of emergencies. First, federal and local governments governed through emergency, enacting temporally bounded governmental strategies that presumed scarcity, triaged care, and naturalized structural inequality by delinking the effects of racism from its causes. This response was spectacular and anticipatory—designed to safeguard the status quo until "normalcy" could be restored. This approach exacerbated two existing endemic emergencies: (1) the slow emergencies racially marginalized populations have faced for decades due to neoliberal restructuring and fragmented care infrastructure and (2) the sacrifice of lower-income frontline workers to premature death to safeguard the economy and protect the middle class. [ABSTRACT FROM AUTHOR]

To examine the association between area-level socioeconomic deprivation and orbital trauma among emergency ophthalmology consults. We conducted a cross-sectional study using 5-year Epic data for all hospital-based ophthalmology consults at the University of Maryland Medical System, and the Distressed Communities Index (DCI) data for area-level socioeconomic deprivation. We ran multivariable logistic regression models adjusting for age to compute odds ratios (OR) and 95% confidence intervals (CI) for the association between the DCI quintile 5 distressed score and orbital trauma. A total of 3,811 cases of acute emergency consults were identified, of whom 750 (19.7%) had orbital trauma and 2,386 (62.6%) had other traumatic ocular emergencies. The odds of orbital trauma among people living in a distressed community were 0.59 (95% CI 0.46–0.76) times the odds for those living in a prosperous community. Among White subjects, the odds of orbital trauma for people living in a distressed community were 1.71 (95% CI 1.12–2.62) times the odds for those living in a prosperous community; among Black subjects, the OR was 0.47 (95% CI 0.30–0.75; p-interaction = 0.0001). Among women, the OR for orbital trauma among those living in a distressed community was 0.46 (95% CI 0.29–0.71); among men, the OR was 0.70 (95% CI 0.52–0.97; p-interaction = 0.03). Overall, we found an inverse association between higher area-level socioeconomic deprivation and orbital trauma among both men and women. The association varied by race, such that there was an inverse association with higher deprivation among Black subjects in contrast to a positive association among White subjects. [ABSTRACT FROM AUTHOR]

The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings. [ABSTRACT FROM AUTHOR]

Objective Design Setting Animals Interventions Measurements and Main Results Conclusions To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist‐obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS.Multicenter, retrospective, case–control study from 2017 to 2021.Private referral center and veterinary teaching hospital.One hundred and thirty‐five client‐owned dogs that underwent diagnostic echocardiography.None.Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI] = 0.90 [0.84–0.95], P < 0.0001) and PHS10 (AUC [95% CI] = 0.89 [0.81–0.97], P < 0.0001). PHS8 ≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR−] 0.37). PHS10 ≥ 3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR− 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC] = 0.74 [95% CI: 0.66–0.80], n = 135).Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsA U. S. and European joint effort fostering the development of medical countermeasures (MCMs) operable in case of radiological or nuclear emergencies.Based on the joint engagement between the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and the French Institut de Radioprotection et de Sûreté Nucléaire (IRSN), a Statement of Intent to Collaborate was signed in 2014 and a series of working group meeting were established. In December 2022, the NIAID and IRSN hosted a five-day, U.S./European meeting titled ‘Radiation-Induced Cutaneous and Gastrointestinal Injuries: Advances in Understanding Pathologies, Assessment, and Clinically Accepted Practices’ in Paris, France. The goals of the meeting were to bring together U.S. and European investigators to explore new research avenues for the medical management of skin and gastrointestinal injuries, including specific diagnostics for each organ system, animal models, and promising medical countermeasures (MCMs) to mitigate radiation damage. There was also an emphasis on exploring additional areas of medicine and response to understand best practices from other emergency scenarios, which could be leveraged to improve radiation preparedness, and the importance of accurate dosimetry in preclinical work.Subsequent to the workshop, seven collaborative projects, funded by both organizations, were established on topics ranging from MCMs and predictive biomarkers, and using physical methods to assess cutaneous radiation injuries, to mechanistic studies to understand radiation-induced damage in multiple organ systems. The importance of accurate dosimetry in preclinical works was highlighted and two recently published U.S./European commentaries that focus on the need for dosimetry standardization in the reported literature had their origins in this meeting. This commentary summarizes the workshop and open discussions among academic investigators, industry researchers, and U.S. and IRSN program representatives.Given the substantive progress made due to these interactions, both groups plan to expand out these meetings by incorporating high-level investigators from across the globe, while endeavoring to maintain the informal setting that was conducive to in-depth scientific discussion and enhanced the state of the science in radiation research. [ABSTRACT FROM AUTHOR]

Background: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. Scope and findings: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. Conclusions: Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes. [ABSTRACT FROM AUTHOR]

Objective: Cathelicidin is a crucial antibacterial peptide that is produced in the urinary system and is induced by vitamin D. In order to distinguish between lower and upper urinary tract infections (UTIs), the association between cathelicidin levels and vitamin D levels was examined in this study. Material and Methods: We analyzed complete blood count, biochemistry profile, C reactive protein (CRP), 25 hydroxyvitamin D, serum cathelicidin levels of pre-treatment children aged 0-18 years who were diagnosed with a UTI in the Pediatric Emergency Room. Results: A total of 72 children (36 healthy and 36 patients) were included in the study. The mean age of the participants was 83.8±66.22 months, with 40 (56%) female and 32 (44%) male. Our patient group had higher white blood cell, neutrophil, and CRP levels than our control group (p=0.050). There was no significant difference in cathelicidin levels (5.7±3.7; 9.6±10.9; p=0.810) or vitamin D levels (23.3±9.5; 25.9±12.5; p=0.795) between patients with lower and upper UTI. We found a positive correlation between vitamin D and cathelicidin levels in the control group (r=0.346, p=0.030). There was no statistically significant difference in cathelicidin levels between patients with upper UTI and the control group (p=0.054). Conclusion: Although there was no significant relationship between vitamin D and cathelicidin levels in children with urinary tract infections, a weak but positive correlation exists between vitamin D and cathelisidin in healthy children. [ABSTRACT FROM AUTHOR]

Natural disasters present a significant and growing threat to the well-being of children. Every year 175 million children globally are expected to be affected by natural disasters, including floods, cyclones, droughts, heatwaves, severe storms, and earthquakes. In emergencies, children of all age groups, especially those under 5, are the most affected part of the community, with child mortality rates 2-70 times higher than average. Clean water, sanitation and hygiene measures, vaccination to prevent infectious diseases, providing psychological support to vulnerable children in an age-appropriate approach, and paying particular attention to children with special needs are extremely important. Healthcare personnel and families should have adequate information and preparation to do what is necessary before, during, and after emergencies to minimize the negative effects on children. In this review, we aim to discuss the effects of emergencies on children and the prevention methods. [ABSTRACT FROM AUTHOR]

Introduction: Video laryngoscope (VL) technology improves first‐pass success. The novel i‐view VL device is inexpensive and disposable. We sought to determine the first‐pass intubation success with the i‐view VL device versus the standard reusable VL systems in routine use at each site. Methods: We performed a prospective, pragmatic study at two major emergency departments (EDs) when VL was used. We rotated i‐view versus reusable VL as the preferred device of the month based on an a priori schedule. An investigator‐initiated interim analysis was performed. Our primary outcome was a first‐pass success with a non‐inferiority margin of 10% based on the per‐protocol analysis. Results: There were 93 intubations using the reusable VL devices and 81 intubations using the i‐view. Our study was stopped early due to futility in reaching our predetermined non‐inferiority margin. Operator and patient characteristics were similar between the two groups. The first‐pass success rate for the i‐view group was 69.1% compared to 84.3% for the reusable VL group. A non‐inferiority analysis indicated that the difference (−15.1%) and corresponding 90% confidence limits (−25.3% to −5.0%) did not fall within the predetermined 10% non‐inferiority margin. Conclusions: The i‐view device failed to meet our predetermined non‐inferiority margin when compared to the reusable VL systems with the study stopping early due to futility. Significant crossover occurred at the discretion of the intubating operator during the i‐view month. [ABSTRACT FROM AUTHOR]

Les situations de crise sont fréquentes à l'adolescence. Le Dispositif Départemental Réactif pour Adolescents (DDRA31) a été implanté en 2017, en Haute-Garonne, pour offrir rapidement, aux adolescents en crise, une consultation spécialisée de psychiatrie avec un accompagnement de trois mois. Notre objectif était de mesurer l'effet de l'implantation de ce dispositif sur l'évolution de l'incidence annuelle des consultations aux urgences et hospitalisations des adolescents pour motif psychiatrique au CHU de Toulouse, guichet hospitalier unique de leur prise en charge en Haute-Garonne. Nous avons conduit une étude quasi expérimentale mesurant l'évolution avant-après l'implantation du DDRA31, l'incidence annuelle des passages aux urgences (pédiatriques et adultes) et d'hospitalisation pour motif psychiatrique au CHU de Toulouse parmi la file active annuelle de tous les adolescents âgés de 12 à 17 ans révolus, résidant en Haute-Garonne, de 2014 à 2019. Les facteurs associés au risque d'hospitalisation ont été analysés par régression logistique à effet mixte pour mesurer l'effet du dispositif au cours du temps, avec l'année comme variable explicative principale, ajusté sur le sexe et l'âge. De 2014 à 2019, 6686 passages aux urgences, réalisés par 4245 adolescents ont été observés. Le taux annuel d'incidence de passage aux urgences pour motif psychiatrique était stable, passant de 14,0 (IC 95 % : 13,2–14,9) pour 100 adolescents en 2014, à 13,9 (IC 95 % : 13,2–14,7) pour 100 adolescents en 2019. L'incidence annuelle des hospitalisations a diminué significativement de 38,3 (IC 95 % : 34,1–42,8) pour 100 adolescents en 2014 à 24,2 (IC 95 % : 21,2–27,4) pour 100 adolescents en 2019. La modélisation du risque d'hospitalisation montrait une réduction significative à partir de 2017, avec un rapport de cotes passant de 0,63 (IC 95 % : 0,49–0,80) en 2017 à 0,52 (IC 95 % : 0,41–0,67) en 2019. Nous n'avons pas montré d'effet du dispositif sur l'incidence annuelle du passage aux urgences pour motif psychiatrique mais un effet possible sur la réduction du risque d'hospitalisation en psychiatrie, suite à un passage aux urgences. La mise en place de structures ambulatoires réactives pourrait diminuer la sollicitation de services d'hospitalisation sous tension. Crisis situations are common during adolescence. Current data show that adolescents in crisis are either directly referred to hospital psychiatric emergency rooms, or they make an appointment for a specialized consultation, in a medical-psychological center (CMP), in a medical-psychological-pedagogical center (CMPP), or with a private practitioner. The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne. We conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age. From 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019. The fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective. Our study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. The implementation of reactive ambulatory structures could therefore reduce the demand on hospitalization services that are under pressure. [ABSTRACT FROM AUTHOR]

Aim: Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma‐related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. Method: Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3‐year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. Results: A total of 455 patients were included (median follow‐up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24–5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35–0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92–5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01–8.69), p < 0.001] were risk factors for late SRCs. Conclusion: Stoma‐related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting. [ABSTRACT FROM AUTHOR]

Objective Method Results Discussion Public significance To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED.The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit.Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty‐three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record.Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment.People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment. [ABSTRACT FROM AUTHOR]

Background: Fecal impaction is a digestive system disease, that is most common in the elderly population and becomes more prevalent with increasing age. Manual removal can successfully remove the impaction in 80% of fecal impaction cases. In severe cases, endoscopy and surgery may be necessary. Case presentation: A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction. Conclusion: Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen. [ABSTRACT FROM AUTHOR]

This paper investigates a purchaser's optimal procurement strategy under emergencies. The occurrence of emergencies often leads to sharp fluctuations in prices and weakens supply stability, which increases procurement risks for purchasers. In this study, we use the option contract to actively respond to market fluctuations and reduce procurement risks caused by emergencies. If there is insufficient inventory due to occurrence of emergencies, part or all of the shortages can be met by an emergency replenishment. Then, we conduct an in-depth research on the optimal option procurement strategy for purchasers under emergencies. The results show that, a higher emergency replenishment rate leads to a smaller option purchase quantity if the shortage cost is not considered, since the emergency replenishment can save part or all of the shortages. If the shortage cost is considered, both over-purchasing and under-purchasing of options lead to corresponding losses, and then the trend in a purchaser's optimal option purchasing decision is decided by the dominance of the two types of losses. Finally, we summarize the results of the study to give managerial insights into the optimal option purchasing strategies for purchasers under emergencies. [ABSTRACT FROM AUTHOR]

Background: Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. Methods: We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. Results: Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain. Conclusions: Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized. [ABSTRACT FROM AUTHOR]

Times of crisis provide fertile ground for corruption because of looser regulatory frameworks, weaker oversight, and skyrocketing financing levels. Public procurement systems are particularly vulnerable to corruption risks over emergency periods as they are at the frontline of many country responses to crises. In this paper, we propose a curated selection of red flag indicators of corruption risk over crises and discuss a general measurement framework for their computation. The proposed approach exploits the time discontinuity introduced by a crisis and allows us to characterise and differentiate companies and/or contracting authorities with different degree of risk through statistical testing. The suggested framework is intended to accommodate the changing and far-reaching corruption risks induced by crises and mitigate them effectively. [ABSTRACT FROM AUTHOR]

Background: Ocular trauma is a debilitating condition and one of the most important and leading causes of visual impairments that have high socioeconomic consequences. Objectives: This study aims to investigate the epidemiology of ocular trauma in patients referred to a tertiary center in northern Iran. Materials & Methods: This cross-sectional study was carried out on 476 patients with ocular trauma referred to the eye emergency department of a teaching hospital in Guilan Province, north of Iran, in 2020-21. Personal and trauma-related information was extracted from the patient's medical records using a checklist. Results: Most patients were in the 31-40 age group (28.8%), with a mean age of 41.5±17.4 years. Most of the injuries occurred at home (57.1%). Few of the patients had used eye safety glasses (5.3%). Most of the patients were living in the city. Closed globe injuries were the common types of traumas (96%), and the prevalence of open globe injuries was at a very low level (4%). Conclusion: Closed globe injuries are the most common types of ocular traumas in northern Iran. Most of the ocular traumas are preventable using eye protection equipment. [ABSTRACT FROM AUTHOR]

In this segment of the emergency palliative care case series, we present a patient who arrives at a small community emergency department with acute intracranial hemorrhage, aspiration, and respiratory failure. Usual care includes aggressive airway management with intubation and mechanical ventilation, and a recommendation from stroke neurologists and neurosurgeons at the tertiary care center to transfer the patient. The patient's wife has some understanding that the prognosis is likely to be poor, and asks that the patient not be transferred if he is unlikely to return to independent function. A general neurologist is consulted to provide a prognostic opinion, and goals-of-care discussions are facilitated by a palliative care consultant. After expedited evaluation, the neurologist provides a prognostic assessment, while the palliative care clinician explores potential next steps with the patient's wife, based upon his known goals and values, ultimately leading to high-value goal-concordant end-of-life care for the patient and his family. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. Methods: A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365‐day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non‐MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. Results: Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio‐Economic Advantage and Disadvantage. Conclusion: Representations associated with MHDAS have a different trajectory of representation episodes compared to non‐MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens. [ABSTRACT FROM AUTHOR]

Objective: An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families. Methods: A qualitative study guided by a phenomenological interpretive approach was employed. Semi‐structured interviews were conducted with ED doctors and nurses across Australia. Data were thematically analysed using a seven‐stage data analysis framework. Results: An analysis of the interview data resulted in four major themes: (i) Benefits of Advance Care Directives; (ii) Knowledge and Awareness; (iii) Communication; and (iv) Availability of Advance Care Directive Information. Conclusions: From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end‐of‐life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs. [ABSTRACT FROM AUTHOR]

House calls are an important part of medical practice in Switzerland and help reducing the need for emergency room visits. To ensure quality service, the content of the doctor' s bag must be adapted to home practice: Enough to deal with a variety of clinical situations, while sufficiently limited to remain portable. We offer here an updated doctor' s bag content, focusing on the resources needed for diagnosis and treatment. We distinguish between basic items and additional resources that can be used for extended care, particularly in regions with no local health resources. [ABSTRACT FROM AUTHOR]

Tracheal intubation is the gold standard for airway management in emergency medicine, but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA). The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against unfixed ones. In a body donor model, LMA application was evaluated between medical students without previous airway experience and anesthesiologists by comparing the sealing of the larynx using a water column applied to the esophagus. LMAs were successfully applied in 46 out of 55 (83.6%) attempts by medical students and in 30 out of 39 (76.9%) attempts by anesthesiologists. Among medical students, 14.1% of all LMA applications were primarily leaky, compared with 18.8% in anesthesiologists. Esophageal sealing was better in Thiel-fixed specimens (leakage 10.9%) compared with unfixed specimens (leakage 22.9%). Our data showed no significant difference between anesthesiologists and medical students in terms of sealing of LMA. Therefore, we conclude that medical students without previous airway experience can quickly learn to apply LMA sufficiently and thus, achieve aspiration protection similar to anesthesiologists. Medical students without previous airway experience can successfully insert LMAs after a short introduction. Thiel-fixed specimens are suitable for studies as well as for training in LMA application. [ABSTRACT FROM AUTHOR]

This article problematizes the recent comeback of the exceptionalist jargon as it is conjured by both critics and sympathizers. While in the last decades governments across the globe had recourse to emergency measures to cope with far-reaching emergencies, from terrorism to the COVID-19 pandemic, the received view has it that political power takes advantage of states of emergency as they put themselves in the position to circumvent constitutional limitations. Carl Schmitt is claimed to be the major advocate of this conception of emergency politics in that he elaborated on the concept of the state of exception as the heart of the state political power. This article contends that the received view is doubly wrong. First, soon after his espousal of exceptionalism, Schmitt realized that emergency legislation is an ineffective and costly governmental device that should be transitory and is as unstable as the crisis it is meant to overcome. Second, the received view neglects how Schmitt came to his model of ultraconservative substantive constitutionalism as he maintained that the main task of politics is to protect the normative life of a limited set of state-sponsored institutions as well as the substantive contents they produce. [ABSTRACT FROM AUTHOR]

In 2019, after decades of attempting to raise awareness of the need to take action, the climate movement saw a surge in its ability to mobilize citizens and influence the political agenda. A younger generation leading the movement has given renewed vigour to the movement's discourse by emphasising the need to act immediately by expressing the idea of emergency. This article suggests that this notion, one that is central to the current youth climate movement, includes an acceleration of time and a discourse based on hope. These ideas have worked as an activator of action complementing or nuancing narratives about future and climate change. The analysis of the discourse of Fridays For Future Barcelona on social media (Twitter and Instagram) with a mixed methods approach shows first the centrality of the notion of emergency in the public discourse of the movement and its role in making the future seem not so distant. Secondly, it shows how the use of emergency speech is linked to a positive view of the future and to a generational discourse. And, finally, it has been detected that using emergency speech together with references to a hopeful future increases the impact of the movement's social media posts. [ABSTRACT FROM AUTHOR]

Background: Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience. Methods: A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 – January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher's exact test. Results: Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p =.010). Type of specialty or years of practice did not affect awareness. Conclusions: Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally. [ABSTRACT FROM AUTHOR]

Background: Nurse motivation can have a significant impact on the quality of cardiopulmonary resuscitation and the patients’ survival. Therefore, the present study aimed to examine nurses’ motivation for performing cardiopulmonary resuscitation. Methods: This cross-sectional study focused on 217 nurses in a teaching hospital in Iran, in 2023. A random sample of nurses was selected from four hospital departments (emergency, critical care, medical, and surgery). These nurses completed the demographic information and motivation for cardiopulmonary resuscitation questionnaires. The data were analyzed using Mann-Whitney, Spearman coefficients, and Kruskal-Wallis and multiple linear regression tests. Results: The mean score of the dimension of the feeling of achievement (4.10 ± 0.50) was high in the nurses’ motivation for performing cardiopulmonary resuscitation. There were more motivational factors in the emergency department compared to the other departments in terms of the feeling of achievement, high chance of success, low chances of success, recognition and appreciation, perceived importance, and beliefs (p < 0.05). The nurses who had participated in cardiopulmonary resuscitation workshops and had a bachelor’s degree had a higher mean score in the dimension of perceived importance (p < 0.05). The correlation coefficient showed that there was a significant negative correlation between the nurses’ frequency of participation in cardiopulmonary resuscitation and their motivation scores in the dimensions of the feeling of achievement(r=-0.170), low chances of success(r=-0.183), perceived importance (r = -0.302), and beliefs (r = -0.250; p < 0.05). The department variable predicted the motivation score in the dimensions of feeling of achievement, high chance of success, low chance of success, perceived importance, and beliefs. The sex variable predicted the motivation score in the dimensions of facilitator of resuscitation and high chance of success. Besides, the variable of years of membership in the CPR team predicted the motivation score in the feeling of achievement and high chance of success (p < 0.05). Conclusion: Nurses would be more motivated to perform a quality cardiopulmonary resuscitation if they had a feeling of success. The nurses’ motivation was affected by certain factors such as their department, sex, education level, years of membership in CPR team, number of participation in CPR, and participation in educational workshops.Key Points: • Despite the improvement in CPR guidelines, survival rates remain low. • A feeling of success in CPR increases nurses’ motivation. • A high level of motivation leads to high-quality CPR. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the shelf‐life and sensory characteristics of a functional instant noodle preparation designed to be used in emergencies as a tactical ration. Instant noodles were selected for their global acceptability and ease of preparation. In this study, semolina flour was used as the main ingredient, and soy protein isolate was added to increase the protein content. Additionally, green tea and beef tallow were incorporated to decrease the likelihood of oxidation. Carboxymethyl cellulose was added to increase the porosity and water absorption of the dry noodles. Spirulina powder was used as a dressing for the final product before serving to increase the nutritional value and provide the consumer with the required vitamins and minerals of the day. Physical, chemical, and organoleptic properties were assessed at multiple timepoints in a 120‐day period to perform an accelerated shelf‐life test by determining their critical moisture content and moisture sorption isotherm curves at 30, 45, and 55°C. The shelf‐life of the product was evaluated to be 1197.28 days at 30°C and 75% relative humidity in aluminum pouches. In conclusion, the product is shelf‐stable at room temperature and is recommended to be stored and used in disaster conditions such as earthquakes, floods, and wars. [ABSTRACT FROM AUTHOR]

Background: To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). Methods: This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients who were admitted, after presenting to both EDs, and were assessed using the existing senior ED clinician assessment, were included in the study. Patients in the intervention group were assessed with the assistance of START, while patients in the control group were assessed without the assistance of START. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. Results: A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The proportion of patients meeting the 4-hour length of stay thresholds was similar between the intervention and control groups (30.1% vs. 28.2%; p = 0.62). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 min, interquartile range (IQR) 221.0–565.0 min versus 383 min, IQR 229.25–580.0 min; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. Conclusion: In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To reduce perceived unnecessary resource use, we modified our tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. We investigated the effect of this change on missed injury, unplanned representation to ED, diagnostic imaging rates and staff satisfaction.A retrospective case series study assessing the 3‐month period before and after the intervention was conducted. Logistic regression analyses were used to examine the association between ordering of computerised tomography (CT) and ED length of stay (LOS), injury severity (ISS), age, surgical review and admission. A staff survey was conducted to investigate staff perceptions of the practice change. Free text data were analysed using inductive content analysis.There were 105 patients in the control and 166 in the intervention group and their mean (SD) ISS was the same (ISS [SD] = 4 [±4] [P = 0.608]). A higher proportion of the control group were admitted (56.3% vs 42.2% [P = 0.032]) and they had a shorter ED LOS (274 min [202–456] vs 326 min [225–560], P = 0.044). The rate of missed injury was unchanged. A surgical review resulted in a 26‐fold increase in receipt of a whole‐body CT scan (odds ratio = 26.89, 95% confidence interval = 3.31–218.17). Just over half of survey respondents felt the change was safe (54.4%), and more surgical (90%) than ED staff (69%) reported the change as positive.The removal of the surgical registrar from the initial trauma standby response did not result in any adverse events, reduced admissions, pathology and imaging, but resulted in an increased ED LOS and time to surgical review. [ABSTRACT FROM AUTHOR]

Background: Fecal impaction is a digestive system disease, that is most common in the elderly population and becomes more prevalent with increasing age. Manual removal can successfully remove the impaction in 80% of fecal impaction cases. In severe cases, endoscopy and surgery may be necessary. Case presentation: A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction. Conclusion: Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To determine the relationship between point‐of‐care β‐hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED.This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length‐of‐stay (LOS), composite mortality/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score/National Early Warning Score [qSOFA/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0 mmol/L and those below 1.0 mmol/L.A total of 311 patients were included from 2377 admissions. Median length‐of‐stay was 4.1 days (IQR 2.1–9.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2 mmol/L (IQR 0.1–0.4). Twenty‐five patients had BHB ≥1.0 mmol/L and five were >3.0 mmol/L. There was no significant difference in median LOS for patients with BHB ≥1.0 mmol/L compared to non‐ketotic patients, 5.3 days (IQR 2.2–7.5) versus 4.1 days, respectively (IQR 2.0–9.8) (P = 0.69). BHB did not correlate with LOS (Spearman ρ = 0.116, 95% confidence interval: 0.006–0.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB ≥1.0 mmol/L, an infective/inflammatory diagnosis was present in 11 (44%), at least 2 days of fasting in 10 (40%) and ethanol intake >40 g within 48 h in 4 (16%).Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression. [ABSTRACT FROM AUTHOR]

Introduction: Prompt, appropriate coagulation factor replacement according to injury and bleeding severity in persons with haemophilia is required to prevent acute and long‐term complications. Aims: Increase proportion of persons with haemophilia A (HA) and B (HB) treated appropriately for an acute injury and bleeding episode at a tertiary children's emergency department (ED) from 65% to 85% and sustain for one year. Secondary aim: increase time interval between patient ED encounters with out‐of‐range factor dosing. Methods: Utilizing quality improvement methodology and plan‐do‐study‐analyze cycles, ED encounters for individuals with HA/HB receiving coagulation factor replacement for injuries were audited for in‐range coagulation factor dosing. Goal factor dose defined as 50% correction for minor bleeds and 100% correction for major bleeds. Optimal dosing range defined as 90%–120% of the calculated goal dose to account for vial size variability. Interventions targeted communication via the EMR problem list and optimization of physician education. Results: Our previous publication demonstrated 33.3% of ED encounters with out‐of‐range factor replacement. Following several interventions, the cumulative rate of encounters with out‐of‐range dosing decreased to 18%. Overall, there was an increase in the mean percent of encounters receiving optimal factor dosing for both HA/HB compared to baseline (82.2% vs. 71.1%), though this was not a statistically significant difference. Conclusion: Despite implementation of multiple interventions, out‐of‐range factor dosing continues to occur. Our team plans to reinstate simulation center education for ED staff and continue education efforts of pharmacists and hematology trainees with the goal of further reducing out‐of‐range dosing in our ED. [ABSTRACT FROM AUTHOR]

Background & Objective: COVID-19 forced us to develop adaptive ways to the new normal of healthcare delivery. Neurology has one of the most diverse types of patients who require urgent, prolonged and multidisciplinary care. This study aimed to understand the impact of the unprecedented community lockdown among patients with chronic and new onset neurologic conditions on emergency room (ER) utilization in a single tertiary hospital in Makati City, Philippine. Methods: We retrospectively examined all consecutive neurology referrals made at the ER from March to August 2020 and compared them with a control group consisting of all ER neurology referrals during the same months in 2019. Results: There was a 45% decline in the volume of referral to neurology service at the ER during the first 6 months of the lockdown period. There were fewer females who sought emergency neurologic care (p=0.019). The average age of patients increased from 55.5 years (σ=19.9) in 2019 to 59.5 years (σ=18.4) in 2020 (p<0.001). The top three chief neurologic complaints in 2019 were dizziness (17.7%), motor weakness (14.1%), and headache (13.2%). In 2020, the top three neurologic complaints where motor weakness (19.0%), decreased level of consciousness or loss of consciousness (13.2%), and dizziness (11.2%), (p<0.001). The average time from symptom onset to ER admission in 2019 was 5.1 days (σ=23.9) which increased to 8.4 days in 2020(σ=28.1), (p<0.001). The proportion of patients with no co-morbidities at the ER decreased from 27.6% in 2019 to 17.0% in 2020 (p<0.001). Patients with pre-existing cardiovascular diseases, endocrine diseases, pulmonary diseases, renal diseases, cancers, and others have significantly increased (p<0.05). However, the increase in the proportion of patients with pre-existing neurological disorders (p=0.143) was not statistically significant (p>0.05). The only pre-existing neurologic conditions with significantly increased in proportion was stroke (p=0.010). Among new onset neurologic diagnoses, headache and facial pain (p<0.001) and peripheral and other neuropathies (p=0.005) significantly decreased in proportions while proportions of cases with new stroke or vascular pathology (p<0.001) and encephalopathy (p=0.003) have significantly increased. ER dispositions showed a significant (p<0.001) decrease in proportions of patients who were admitted, discharged, and transferred to hospital of choice; while patients who were discharged against medical advice and who died at the ER have significantly increased. Conclusion: The initial six months of community lockdown during COVID-19 pandemic caused a significant change in the characteristics of patients referred to neurology for emergency care. These changes provide us a new perspective on how to better deliver optimal neurologic care to these diverse patients especially during times of pandemic. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications. We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates. We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4–24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3–2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32–0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15–8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08–12.53; high certainty). When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine. [ABSTRACT FROM AUTHOR]

In this article, I claim that demographic engineering scholarship cannot adequately explain the production of demographic engineering practices because they suffer from two classic limitations of state theory: (1) assuming the political elite to be the sole producers of the state practices, and (2) treating the state as an actor. Following the latest theoretical insights on the complex ontology of the state, I claim that we can overcome these limitations of the current demographic engineering scholarship by focusing on interactions between political and bureaucratic actors involved with the demographic engineering policy. I use this insight to examine the population control policy of the Indian state during the Emergency period (1975–1977). My main finding is that the strategies of federal bureaucrats to reproduce their authority over the regional bureaucrats, lowered by political elite dynamics during the Emergency period, enabled the street-level bureaucrats to adopt coercive strategies for achieving their unrealistically high sterilization targets. My study contributes to the studies on demographic engineering, state theory, and the Emergency period in India by highlighting the significance of studying interactions among the political and bureaucratic actors in producing state practices, including but not limited to demographic engineering. [ABSTRACT FROM AUTHOR]

Approximately 170 pediatric surgeons are needed for the 24 million children in Uganda. There are only seven. Consequently, general surgeons manage many pediatric surgical conditions. In response, stakeholders created the Pediatric Emergency Surgery Course (PESC) for rural providers, given three times in 2018-2019. We sought to understand the course's long-term impact, current pediatric surgery needs, and determine measures for improvement. In October 2021, we distributed the same test given in 2018-2019. Student's t -test was used to compare former participants' scores to previous scores. The course was delivered again in May 2022 to new participants. We performed a quantitative needs assessment and also conducted a focus group with these participants. Finally, we interviewed Surgeon in Chiefs at previous sites. Twenty three of the prior 45 course participants re-took the PESC course assessment. Alumni scored on average 71.9% ± 18% correct. This was higher from prior precourse test scores of 55.4% ± 22.4%, and almost identical to the 2018-2019 postcourse scores 71.9% ± 14%. Fifteen course participants completed the needs assessment. Participants had low confidence managing pediatric surgical disease (median Likert scale ≤ 3.0), 12 of 15 participants endorsed lack of equipment, and eight of 15 desired more educational resources. Qualitative feedback was positive: participants valued the pragmatic lessons and networking with in-country specialists. Further training was suggested, and Chiefs noted the need for more trained staff like anesthesiologists. Participants favorably reviewed PESC and retained knowledge over three years later. Given participants' interest in more training, further investment in locally derived educational efforts must be prioritized. [ABSTRACT FROM AUTHOR]

The emergency department plays a fundamental role in hospitals and critically affects a hospital's overall efficiency. Inadequate staff planning in emergency departments generates high costs, overcrowding, and patient dissatisfaction due to long waiting times, possibly putting the patient's health and life at risk. This research designed two mixed integer linear programming mathematical models. The first determined the optimal number of physicians required per shift and weekday in an adult emergency department to minimize the deviation between available and required capacity. The results of the optimization model would reduce by 16.07 % the required medical office staff per week, from 56 physicians in the current situation to 47, reducing staffing costs without impacting waiting times. Moreover, the overall physician utilization would be 95.01 % compared to 77.79 % in the current situation, indicating an adequate distribution of physicians on each shift of each day according to patient demand. These results contribute to the problem of high medical staff costs and overcrowding without sacrificing timeliness and quality of care. In contrast, the second model that minimized the number of physicians considering capacity constraints would increase the staff by 7.14 % concerning the current situation. This research was based on a model presented in the literature, but the objective function included the deviation variables as unrestricted in sign and a constraint to ensure that they were positive. The first model designed is presented as a tool to support emergency department managers in the medium-term planning of medical staff, ensuring an optimal solution to this problem. [ABSTRACT FROM AUTHOR]

Background: It may be challenging for practitioners to secure vascular access in animals, especially in a state of shock. Aim: This study aimed to evaluate the clinical relevance of commercial 16‐gauge intravenous (IV) catheter stylet vs. 15‐gauge intraosseous (IO) vascular access in emergencies. Methods: Six healthy dogs were used in this study. After general anaesthesia, IO catheterisation was performed on both trochanteric fossae of the femurs using a commercial 16‐gauge IV catheter stylet and EZIO 15‐gauge IO needle. The pressures were measured by manual, gravity and mechanical infusion for 5 min each. Additionally, insertion time and success rate were recorded. Results: In hand infusion, mean pressure of a 16‐gauge IO (605.06 ± 49.13 mmHg) was statistically lower than that of a 15‐gauge EZIO IO catheterisation (718.84 ± 93.09 mmHg). In gravity infusion, there was no significant difference in pressure during injection between the 16‐gauge IV catheter (52.23 ± 14.48 mmHg) and 15‐gauge EZIO IO catheterisation (50.68 ± 11.89 mmHg). In mechanical infusion, mean pressure of the 15‐gauge EZIO IO catheterisation (128.25 ± 50.16 mmHg) was lower than that of the 16‐gauge IV catheter (152.56 ± 67.23 mmHg). The insertion times of a 16‐gauge IV catheter and 15‐gauge EZIO IO catheterisation were 16.79 ± 0.92 and 11.65 ± 1.70 s, respectively. The success rates of the insertion were similar between both groups. Conclusion: This study shows that IO catheterisation with a commercial IV catheter stylet can be an alternative method of IO catheterisation in an emergency, especially for rapid vascular access. [ABSTRACT FROM AUTHOR]

In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions. Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios. [ABSTRACT FROM AUTHOR]

The climate change emergency is one of the most important challenges of our time, and its impact on mental health has been evident for years. It is very important for clinicians to delve deeper into these manifestations. There are a wide variety of constructs, symptoms, and scales to measure the impact of climate change on mental health. Eco-anxiety is one of the constructs that has specifically emerged, in association with worry, about the future. In mental health studies, it is important to explore the relationship between eco-anxiety and emotion regulation and how much this relationship leads to worry about the future in order to be able to offer clinical intervention recommendations. Indeed, the hypothesis of this study is that it is possible to develop worries about the future when symptoms of eco-anxiety and a poor ability to regulate emotions are present. Particularly, emotion dysregulation could increase eco-anxiety symptoms and generate worries about one's own future. For this reason, we have chosen to explore the relationships between these three constructs with the use of a mediation analysis. For this research, 351 participants were recruited in Italy. The proposed mediation model highlighted the findings that emotion dysregulation was positively related with eco-anxiety and that eco-anxiety predicts worry about the future. An association between emotion dysregulation and worry about the future was present. Eco-anxiety appeared to be an important mediator between emotional dysregulation and worry about the future. Emotion regulation could play a pivotal role in addressing concerns about the future. These findings could pave the way for exploring new research avenues and potential clinical interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postpartum posttraumatic stress disorder (PTSD) can occur in women who give birth after emergency admission. The identification of risk factors for this condition is crucial for developing effective preventive measures. This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission. METHODS: Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023. The patients' general conditions and perinatal clinical indicators were recorded. The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum. Multivariate logistic regression analysis was performed to identify risk factors. RESULTS: A total of 276 puerperae were included, with a PTSD incidence of 20.3% at six weeks postpartum. Multivariate logistic regression analysis identified emergency cesarean section (odds ratio [OR]=2.102; 95% confidence interval [CI]: 1.114-3.966, P=0.022), admission to the emergency department after midnight (12:00 AM) (OR=2.245; 95%CI: 1.170-4.305, P<0.001), and cervical dilation (OR=3.203; 95%CI: 1.670-6.141, P=0.039) as independent risk factors for postpartum PTSD. Analgesia pump use (OR= 0.500; 95%CI: 0.259-0.966, P=0.015) was found to be a protective factor against postpartum PTSD. CONCLUSION: Emergency cesarean section, admission to the emergency department after midnight, and cervical dilation were identified as independent risk factors for postpartum PTSD, while analgesic pump use was a protective factor. These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission. [ABSTRACT FROM AUTHOR]

Background: Snake bite is one of the most common animal bites in Nepal. Different species of snake cause different clinical presentations. The incidence of snakebite is very high in rural Nepal. The objectives were to assess the presenting pattern, demographic profile, outcome, and treatment profiles of snakebite victims admitted to the emergency ward. Materials and Methods: A retrospective cross-sectional study was conducted among the patients who presented in emergency department with alleged history of snake bites from 2015 to 2016. The patient's record files were reviewed and the relevant data were recorded on a self-designed proforma. Descriptive statistics were calculated using SPSS version 11.5. Results: Out of 137 snakebite victims, 73 (53.3%) were female. The mean age was 35.17 ± 18.27 years. The upper limb (59%) was the most common site for snake bites followed by the lower limb (35.1%). Fifty patients (36.2%) were bitten by snakes during night (20.00-2.59 AM). Twenty-eight (20.4%) patients presented with ptosis as the most common sign and symptom followed by diplopia (15.3%). Out of 137 patients, 39 (28.5%) were admitted, 65 (47.4%) discharged, and 12 (8.8%) patients expired. Antisnake venom was given to 30 patients among which 23 patients (76.7%) were improved. Conclusions: Snake bite is one of the major problems in rural Nepal. It can be easily managed if treatment is given properly and in a timely manner. The importance of effective first aid management and effective treatment have to be disseminated among the peoples in rural areas via social media and radio. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to understand the role of courage and interactional justice in the emotional exhaustion of emergency nurses. Background: Nurses judge managers' interactions with them. Rude and inappropriate interactions of administrators with nurses are among the reasons that increase the emotional exhaustion of nurses. A courageous nurse can diminish the negative effect of injustice on emotional exhaustion by voicing this unfairness. Introduction: Increasing nurses' emotional exhaustion due to working conditions is a fundamental problem in the health sector. Perception of justice and courage, studied in organizational psychology, are significant antecedents of emotional exhaustion. Individuals with high courage are more likely to seek support and cope with job demands. Methods: Using the cross‐sectional method, the authors performed descriptive, correlation, and regression analyses to test the hypotheses. Data were obtained from 317 emergency nurses currently working in four public hospitals as emergency nurses or have worked in the last three years. Results: Interactional justice was significantly and negatively related to emotional exhaustion but was positively related to workplace social courage. High courage strengthens the negative relationship between interactional justice and emotional exhaustion. Conclusion: Nurses with high courage can reduce emotional exhaustion by raising a voice to request more respectful, honest, polite, and appropriate communication when their managers do not treat them fairly. Implications for nursing practice and policies: Managers' supportive interventions are necessary and helpful in alleviating stressors that cause emotional exhaustion in nurses. The authorities should see and accept managerial unfairness in health, and steps should be taken toward a solution. There is an urgent need to create a communication environment where nurses can courageously share their problems. [ABSTRACT FROM AUTHOR]

Background: Few studies assessed robotic in emergency setting and no solid evidence was demonstrated. The aim of this study was to evaluate the feasibility and safety of robot‐assisted transabdominal preperitoneal (R‐TAPP) repair for the treatment of incarcerated inguinal hernia. Methods: We retrospectively searched from a prospectively maintained database patients who underwent R‐TAPP or open surgery for incarcerated inguinal hernias from January 2018 to March 2023. The primary endpoint was to assess safety and feasibility of the R‐TAPP compared to the standard approach. For eligible patients, data was extracted and analyzed using a propensity score‐matching (PSM). Results: Thirty‐four patients were retrieved from our database, 15 underwent R‐TAPP, while 19 underwent open surgery. Mean age was 73.1 ± 14.6 years, 30 patients (88.2%) were male and mean BMI was 23.5 ± 3.2 kg/m2. No intraoperative complication occurred. Three cases requiring small bowel resection were all in the open surgery group (p = 0.112). The operative time was 108 ± 31 min versus 112 ± 31 min in the R‐TAPP and open surgery groups (p = 0.716). Seven postoperative complications occurred, only one classified as severe was in the open surgery group. The length of hospital stay was 2.9 ± 1.8 in the R‐TAPP versus 4.2 ± 2.3 min in the open surgery group (p = 0.077). PSM analysis showed similar postoperative outcomes and costs in both groups. Conclusions: Despite its limitations, our study appears to endorse the safety and feasibility of the robotic‐assisted treatment for incarcerated inguinal hernia. This approach yielded comparable results to open surgery, albeit in a limited number of patients, suggesting it might be a viable alternative. [ABSTRACT FROM AUTHOR]

This paper presents the critical egress parameters that influence emergency evacuation in a typical hospital building. A parametric study of a 20-story hospital building is conducted using a computer model "Pathfinder" to simulate the evacuation efficiency and assess the influencing parameters. The main egress parameters that influence the evacuation efficiency, including the location of stairways, number of stairways, location of the fire, exit width, and number of low-speed occupants are varied. Two scenarios are simulated: one being the regular (practice) evacuation drill and the other is the actual fire drill. The result shows that the location of stairways significantly affects the total evacuation time with the optimal stairway arrangement consisting of one stairway outside the core of the building. Similarly, the story level at which the fire occurs is another key parameter with fires at lower levels being critical to dictating the evacuation time in a hospital building. The total evacuation time when the fire occurs between the third and sixth floor is found to be 170 min which is 36% and 15% higher than fires at the top story levels (15–18th floor) and the intermediate story levels (9–12th floor), respectively. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the effectiveness of a screening tool for the differential diagnosis of secondary headaches in acute care. Topics explored include the key questions regarding neurological symptoms and systemic features that admitting medical staff need to ask, the reasonable sensitivity and specificity demonstrated by the screening tool, and the secondary headache diagnoses accounted which range from primary brain tumour to venous sinus thrombosis.

Neuro-ophthalmic emergency refers to the spectrum of neuro-ophthalmic clinical diseases that can seriously threaten patients’ vision or even endanger their lives if they are not diagnosed and treated in time, among which the neuro-ophthalmic emergency caused by vascular causes (vascular neuro-ophthalmic emergency) accounts for the vast majority. Due to the characteristics of interdisciplinary, patients with vascular neuro-ophthalmic emergency are often first referred to the department of ophthalmology or emergency, and the first doctors often have incomplete understanding of the disease, which is easy to lead to delayed diagnosis, misdiagnosis or missed diagnosis of such patients. When patients are referred to the department of neurology, if the neurologist’s diagnosis of the disease cannot be determined in time, it is easy to delay treatment. In this paper, the clinical manifestations, the examination methods and the treatment methods of the major diseases in the spectrum of vascular neuro-ophthalmic emergency were reviewed in order to provide the basis for the rapid diagnosis and accurate treatment of these diseases. [ABSTRACT FROM AUTHOR]

Objective: To determine signalment, injury type, trauma severity score, and outcome of canine trauma patients undergoing surgical (emergency room [ER] or operating room [OR]) and nonsurgical treatment in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Design: Retrospective evaluation of medical record and hospital trauma registry data on canine trauma cases. Setting: University teaching hospital. Animals: One thousand six hundred and thirty dogs presenting for traumatic injury between May 2017 and July 2020. Interventions: None. Measurements and Main Results: Demographics and outcome were compared for canine trauma patients undergoing OR surgery (12.8%, 208/1630), ER surgery (39.1%, 637/1630), or no surgical intervention (48.2%, 785/1630). Among the 2 surgical groups, 98.9% (836/845) survived to discharge compared with 92.2% (724/785) of the nonsurgical group (P < 0.0001). The OR surgical group had significantly higher median Animal Trauma Triage scores (2 vs 1, P < 0.0001) and median days in hospital (2 vs < 1, P < 0.0001) compared with the other groups. For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (45.2%, 94/208) and general surgery (26.9%, 56/208). Neurology and general surgery cases required the longest median length of stay in hospital, and ophthalmology and dentistry cases required the shortest. The median cost of visit was highest in neurology ($10,032) and lowest in ophthalmology ($2305) and dentistry ($2404). Conclusions: Surgical intervention in canine trauma patients appears to be associated with higher survival rates, and among the surgery groups, mortality was highest in the ER and general surgery groups. OR surgical intervention, in particular general surgery and neurology, was associated with increased length of hospitalization, increased cost, and higher Animal Trauma Triage scores. [ABSTRACT FROM AUTHOR]